Wednesday, December 16, 2009

Scientific Medical Journals and the Media

One would think a doctor might like to read the article, especially one dealing with defibrillators.

So I checked late last night and wouldn't you know, no such article was on-line. Then I checked again early this morning. Still no reference on line. I checked Google. I checked Circulation: Heart Failure's website. I checked for the press release on the American Heart Association's press release web page.

No such article.

But Reuters had seen it (I think) (or at least they saw the American Heart Association's press release about the article, I really don't know).

And so I waited and waited, only to find that the article was finally posted on-line publically on the Circulation: Heart Failure's website at about 12-1PM CST, almost a full 18 hours later the manuscript was reported upon by the main stream media.

The article certainly has plenty to comment upon, but I will forgo that for the moment and instead focus on this disturbing trend of media releases pitched to journalists before the scientific community.

Given that this study was funded by GlaxoSmith Kline and the journal Circulation: Heart Failure is published by the American Heart Association who acknowledges multimillion dollar funding from the pharmaceutical and medical device companies we have to wonder: why are physicians being left out of the opportunity to critically review scientific publications before mainstream media broadcasts information to our patients and the public? Might it be that the sponsors of these trials might not like what certain doctors might say about the study? Or are such press releases being more like classic TV ads hoping to prod patient's to "Ask Your Doctor" about study's findings? What potential implications might these press releases have on public policy mandating doctors to "Get With the Guidelines" for the treatment of heart failure going forward?

I find the feeding of jounalists these manuscripts before the very scientists who subscribe to the these journals troubling at best and potentially subversive and manipulative at worst.

12 comments:

As a professional medical journalist for more than 25 years please allow me to respond.

1. I don't know the specifics of this particular episode but in general you should never be able to see a newspaper report about a journal article without the article being available online. That's the way the embargo system works. (It's a little different at medical meetings, though.) Occasionally people make mistakes, of course. Occasionally a journalist breaks, usually inadvertently, an embargo. Occasionally a publisher has a glitch in their publishing system and an article that was supposed to go online at a certain time fails to do so. But usually the system works as expected.

2. I also think Dr Wes misunderstands the real purpose of the embargo system. It's not a perfect system, but it does allow genuine, accredited journalists a chance to write better balanced and thoughtful articles than would otherwise be possible in the context of a short deadline. Scientific and medical matters are frequently far too complex for an individual journalist to immediately comprehend and put in perspective. Among other things, the embargo system allows the journalist to solicit the perspective of outside experts in the field. Like anything else, the embargo system can be abused, but its general point and purpose is to make it easier for the journalist to write a competent news report.

3. I don't think it would be possible to release the articles to the scientists before journalists and others. That would be an invitation to a very leaky system!

In this master of the obvious' opinion, look no further than the over application of ICD therapy garnered from SCD-Heft and MADIT II trials. These trials enrolled specific patient cohorts with limited co-morbid illnesses, but yet, what came of this was low EF=ICD. It almost validated the predatory implant docs.

This blogger's wife, a palliative care MD, has had the need to turn off an ICD in a patient with end stage disease, whose ICD implant site still had steri-strips.

Or, the implantation of ICD's in patients with CHF due to Afib and rapid rates whose EF will reverse with AF treatment. and the examples of failing to master the obvious goes on...

My point is that the sophisticated medical community has plenty of trouble vetting science as it is. The headline hungry, news ticker reading general public is at great risk of misinformation. Many moons ago, as one of my former wise old professors, Harvey Feigenbaum repeatedly said most Thursday afternoons at the IU Echo conference was "no data was better than bad data."

I also think Dr Wes misunderstands the real purpose of the embargo system. It's not a perfect system, but it does allow genuine, accredited journalists a chance to write better balanced and thoughtful articles than would otherwise be possible in the context of a short deadline.

Thanks for your thoughtful comments, but I cannot help but wonder why only selected articles are pushed to mainstream media for review and commentary. In the ideal unbiased world of reporting, shouldn't all articles be available for your review? Or might another funding authority have a vested interest in making sure the good news about their drug or device receive top billing in headlines?

And then there's the whole issue of who decides which articles are "locked" and unlocked (available for free) on medical journal websites. Why are articles dealing with a political viewpoint or particular expensive therapy "unlocked" for the publics' review for free, and yet other possibly more conservative therapy articles unfunded by industry left "locked" and available just for subscribers? Should we willingly ignore this reporting bias to the public?

Finally, while I very much appreciate the efforts of skilled journalists like yourself and the perspectives they can bring to a reported study, folks who pay for prescriptions (or are members in whom their membership fee pays for a prescription) should get first dibs on the content provided before any mainstream media gets a chance to view the content for free.

I honestly don't believe there's a "political" angle to this whole issue. It's very easy to look at one paper or one incident and read all kinds of meaning into it. Overall, the main motivation for most journals and scientific societies is simply to get their names in the papers and to raise their visibility. If you really believe there's something more nefarious going on then I think you will need to document this in a much more rigorous way.

Finally, I am going to congratulate myself profusely for refusing to capitalize on your amusing slip of the keyboard, ie, substituting "prescriptions" for "subscriptions." I do however agree that ultimately those who pay for prescriptions (that is, all of us) have a need and a right to the best possible medical journalism.

Dr. Wes, I think you are right on with this comment. I have followed AHA for a long time since they received a large donation and suddenly started the "stroke attack" movement- -pushing a treatment that at the time over 50% of ER docs thought was dangerous into the zone of "standard of care". If we can't connect the dots, we are not looking. You are right on here.

But wait a minute: now you've strayed from one topic to the next. It's one thing to say that policy-related articles in the NEJM have a political bias, it's another thing to say that the entire embargo system is part of a larger political bias. I don't think you should let your disagreement with one type of article in one journal cloud your discussion of all medical journals...

Sorry about the delay getting back to you. (Afib ablations have a way of doing that.) While the embargo system may have its place, in my opinion, people who subscribe to medical and scientific journals should have first dibs at the content. Marketing should always be secondary to medicine or science.

Look at this study reported. It was sponsored by GSK, one of the senior authors has been a paid GSK consultant and speaker and that same author is also a king pin to the Get With the Guidelines Heart Failure program of the AHA, who is also funded by GSK to the tune of over $2 million annually. Not that good work can't happen with industry help - it can. But when these studies are released to the public and the "careful" journalism in theHeart.org, Reuters and the WSJ includes only that same senior author's quotes, we have to wonder if a little reporting bias might occur with the interpretation of the data quality and findings.

I'm not sure we're going to make much progess here! It seems to me that there's a whole lot about the entire medical system that's really bothering you, but I'm not sure if you're helping your point of view by sort of attacking the entire system indiscriminately.

I'd be really curious to know what specifically about this paper, and the news stories that reported it, bothered you.

I for one feel that practicing docs deserve access to these journal articles before the media gets to them. Rarely are these stories so urgent that they need to be rushed to press. At this point, we docs first see data through the lens of the media before we get to read and formulate our own opinion on the data.

The media has no more right to early access than we do. I find what happens is a rush to press that has a journalist calling me to comment on a study I have never seen, then the study gets faxed over to me and I have about 30 seconds to forulate my own "thoughtful response" so the journalist can meet their deadline.

Since when did healthcare news become so urgent to report?

Oh yeah, ever since Pharma stock prices became more important than real medical opinion.

Margaret, you make some good points, but I don't think what you propose is practical. In contrast to physicians and other subscribers to medical journals, the actual number of journalists who take part in the embargo system is very small, and the system is generally able to police itself. Clearly there is no way to effectively enforce an embargo to physicians or subscribers only for an article appearing in any of the major journals. They would be immediately leaked and disseminated, making the situation even worse.

I understand that you and Dr Wes are unhappy and frustrated by the current system, but I think you will need to think through the practical details and propose a workable alternative system before tearing down the current one.

About Me

Westby G. Fisher, MD, FACC is a board certified internist, cardiologist, and cardiac electrophysiologist (doctor specializing in heart rhythm disorders) practicing at NorthShore University HealthSystem in Evanston, IL, USA and is a Clinical Associate Professor of Medicine at University of Chicago's Pritzker School of Medicine. He entered the blog-o-sphere in November, 2005.
DISCLAIMER: The opinions expressed in this blog are strictly the those of the author(s) and should not be construed as the opinion(s) or policy(ies) of NorthShore University HealthSystem, nor recommendations for your care or anyone else's. Please seek professional guidance instead.